Children and Marathoning: How Young is Too Young by Rice and Waniewski outlines the theoretical concerns surrounding the issue of children and adolescents participating in marathon runs. [3] There is little evidence to support the suggested ban on youth participating in marathons and the manuscript offers little advice other than just say no. When I look at injury in youth sports, I find it difficult to single out long distance running even at the marathon level as a significant risk to long term health and well being compared with baseball, ice hockey, soccer, gymnastics, figure skating, and football, or the extreme sports that children and adolescents choose to escape adult supervision. [2] The injury incidence cited for both boys' and girls' cross country running is most likely due to ill advised training programs that encourage excessive summer running in the 300 to 500 mile range to prepare for the 5 k and 4-5 k competitions, respectively, during the high school season. In some states 11-year-old students are eligible to participate in varsity level high school cross country racing.

Although cases and anecdotes do not constitute an evidence base to guarantee the safety of children who choose to run a marathon, my experience with young runners who have entered and completed the Twin Cities Marathon over the past 22 years has not demonstrated any adverse injury patterns. In the mid 80's we were faced with our first 10-year-old to enter the marathon. We were not sure how to proceed and a literature search provided no defensible course of action. In my role as medical director, I called the father who related the following story.

His 10-year-old son had been running shorter distances with the father over the past couple of years and both looked forward to the time together. The father chose to up his running to the marathon level and told his son that he could not run with him at that distance. The father increased his training volume while the son continued to run on his own. One day in the early summer the child asked his father how many times around the block was the same as a marathon. The father thought his son was asking for help solving a math problem and together they calculated the distance at 56 times around the block. He was surprised a few weeks later when his son approached him and stated that he was ready to enter the marathon as he had just finished running around the block 56 times. It had taken him several weeks to build up to the distance. The father was leery but entered the child to run with him. They finished together in the 4-5 hour range. The child stopped by the medical tent after the race at my request. He was fine and looked better than many of the adults in the finish area. To date, none of the under 18 entrants have required care in the medical tent at the marathon finish line.

So what is the point? We have no objective evidence to either restrict or promote running the marathon or other distances above 5K in children and adolescents. We are also faced with gross inactivity in our young population. Even though the no participation expert opinion is well intentioned, given no guidelines people do what they please and often make preventable errors. While I would not encourage children and adolescents to run marathons, the data is not there to prove it any more risky than many of the sports that are promoted for today's youth. The area of greatest concern may not be the race itself, but rather the volume of training required to adequately prepare to run the race as a child or as an adult. I would make the following suggestions for children (and their parents) and road race officials regarding marathon and longer distance road race participation:

Races that choose not to allow competitors from the child and adolescent age categories should state the decision is an administrative choice and not couch the decision in a medical opinion statement.

Marathons and other long distance races should not encourage child and adolescent participation.

Marathons and other distance races should not keep youth age group records below age 18 years and should not publicize the participation of child or adolescent runners.

Self motivated children and adolescents should be allowed to participate, race administration rules permitting, as long as:

They follow an acceptable supervised training program with emphasis on fun and participation, not records and fast times.

They have no injury or pain during training.

They maintain normal growth in height and weight during training.

They remain healthy with good nutritional intake and good sleep patterns.

They maintain good social interaction and academic performance during training.

Girls maintain normal menstrual function.

Children should run the race with an adult and should consider not participating in very large events where it is easy to get lost in the crowd.

Children should not enter a marathon that does not start shortly after sunrise to avoid the hottest part of the day.

Children should not start a marathon if the ambient temperature is above an arbitrary level of 55°F based on odds ratios of adult medical encounters.

Children who choose to train for a marathon should be monitored by a physician who can explain the risks to the child and parents, and who can monitor the physiologic and psychologic parameters.

While the concerns outlined by Rice and Waniewski are legitimate and should be discussed with parents and child/adolescent runners, they do not preclude this age group from participation in marathon running. There is no guaranteed safe running distance and any distance race can be injurious for children and adolescents if training is not judicious and the races are run for the wrong reasons. While the exceptional cases do not make the rule, the suggested guidelines for youth participation in long distance running should make the practice safer and give parents some counsel for the rare youth who choose to participate. Races that do allow children and adolescents to enter should consider tracking them for injury and well being. If we, as a running community, can monitor the activity, we may be able to develop evidence based recommendations that reflect data and not supposition.